Mark Richman

Introduction: Sepsis is a severe health condition that requires rapid and attentive treatment. The rise in sepsis cases reveals a lack of immediate supportive care in the healthcare system. This lapse may be attributed to a delay in sepsis recognition, patient incompatibility with care plan, and conditions that make treatment more difficult. Building on previous research, this paper seeks to explore the correlation between patients with mental health conditions and sepsis development. State how we define quality of sepsis care. Method: Data from 2018-2019 from our ED sepsis quality database was analyzed using T-tests, comparing the characteristics, conditions, and quality of sepsis care of dermatologically-septic patients with and without mental health conditions. Results: Between January 1, 2018 and December 31, 2019, 584 LIJ ED patients had sepsis that met inclusion criteria for quality review. Of these, 57 (9.8%) had sepsis of dermatologic origin, of which 30 (52.6%) were female (p = 0.4318). The source of sepsis was the lower extremity in 36.8% of mental health patients vs. 68.4% of non-mental health patients (p = 0.045) and sacral decubitus ulcer in 36.8% of mental health patients vs. 5.3% of non-mental health patients (p = 0.004). In neither univariate nor multivariate analysis were there statistically-significant differences in outcomes in patients with vs. without a mental health issue. However, the need for mechanical ventilation trended lower among patients with mental health disorder (p = 0.141) while the outcome of 3-hour bundle met trended higher among that same group (p = 0.11). Discussion: Compared to patients with mental health issues, those without mental health issues had higher rates of sepsis due to lower extremity infections and sacral decubitus ulcer infections. None of the outcome variables met statistical significance. However, dermatologic sepsis patients without mental health issues tended to be more sick than those with mental health issues, as gauged by rates of septic shock and ICU admission (both trending toward statistical significance). They also trended toward receiving lower quality care, as measured by adherence with the 3-hour sepsis bundle. Failure to achieve statistical significance might be due to the small sample size. This is likely the case, as, for example, there was a substantial difference in the percent of multi-racial patients between those with (5.3%) vs. without (28.9%) mental health illness, yet even this large difference did not meet statistical significance (p = 0.104).

Introduction: Inappropriate use of echocardiograms and stress tests with nuclear components in the evaluation of cardiopulmonary complaints (chest pain, dyspnea/shortness of breath (SOB), dizziness, and syncope) is common, despite Cardiology society guidelines for appropriate use. Such overuse raises healthcare costs, impairs the availability of resources for other patients, and exposes patients to radiation unnecessarily. Our Emergency Department (ED) runs an observation unit that sees thousands of patients annually with cardiopulmonary complaints. We observed many have echocardiograms and stress tests with nuclear components without indications for either. Working with our Department of Cardiology, we promoted guidelines for appropriate use of echocardiograms and stress tests with nuclear components in the evaluation of such patients. Methods: We collected 2024 and 2025 data regarding OU admissions. Patents were included if they were ≥18 years, in the ED OU between 1/1/24 and 12/31/25, aad an OU admission complaint of chest pain, dyspnea/SOB, dizziness, and syncope. We calculated the percent of patients with such presentations who received either an echocardiogram or a stress test with a nuclear component. We then compared the 2024 (pre-implementation) data with full-year data from the first full year of implementation (2025). Results: After introducing educational guidelines, there were statistically-significant reductions in nuclear stress tests ordered for dyspnea/SOB (absolute reduction 9.3%; p = 0.0009) and overall usage of nuclear stress tests (absolute reduction 2.4%; p = 0.0095). This was offset by increases in echocardiograms ordered for chest pain (absolute increase 3.7%; p = 0.005) and overall usage of echocardiograms (absolute increase 2.0%; p = 0.0454). There was no net change in the overall use of echocardiograms and nuclear stress tests when considered together: 85.2% of patients had one or the other study in 2024 vs. 84.8% in 2025; p = 0.5768. Discussion: Introducing and promoting appropriate-use guidelines for echocardiograms and stress tests with nuclear components in the evaluation of cardiopulmonary complaints was associated with a reduction in unnecessary nuclear stress tests, but not echocardiograms. Success of this program to reduce nuclear stress tests may be attributed to several factors. First, the relevant specialties (emergency medicine, cardiology) were engaged. Second, we relied on guidelines adopted by professional organizations. Third, the initiative corresponds to nationwide efforts to decrease cost of care by providing evidence-based diagnostic and treatment management. Failure to reduce echocardiograms may be due to a well-documented multi-year time lag between changes in medical knowledge and wide-scale adoption; failure to develop the guidelines in collaboration with house staff and mid-level providers and promote them at multiple times and venues in a multi-modal manner; and utilize Department leadership to promote their usage.

Background Point-of-care ultrasound (POCUS) has become an integral tool in clinical practice, particularly in Emergency Medicine (EM). However, prior research of practicing physicians shortly after residency graduation suggests a gap between POCUS training in residency and its consistent utilization post-graduation. This study aimed to assess post-training POCUS usage among EM residency graduates and identify barriers to its consistent use. The objectives were to quantify POCUS usage based on years post-training and number of scans performed during residency, identify barriers to consistent POCUS usage, and propose interventions to increase POCUS utilization in clinical practice.MethodsParticipants included graduates from a specific EM residency program in New York. A survey, conducted in March 2024, was performed assessing POCUS usage, comfort levels with various applications, barriers to use, and potential interventions to increase usage. Statistical analysis was performed to compare usage based on years since training and the number of scans performed during training.ResultsRecent graduates exhibited higher daily or weekly POCUS usage compared to those further from training (p = 0.0042). Higher scan volumes during training correlated with increased post-training usage (p <0.0364). Comfort performing particular POCUS applications varied with years since training and number of scans during training for only a few of the 10 applications assessed (eg, aorta, obstetric (OB)); for the remainder of applications, there was no association between comfort performing and years of practice or number of scans during training. Common barriers to increased use included lack of time, skill maintenance, and reimbursement issues.Conclusion POCUS usage among EM physicians post-residency is inversely associated with time since training and scan volume during residency. Training programs may benefit from emphasizing hands-on experience and higher scan volumes. Continued education and addressing barriers such as time constraints and reimbursement could enhance POCUS utilization post-training, improving patient care and outcomes in EM.

Introduction Maternal mortality rates in the United States remain the highest among high-income countries despite advances in medical care. Simulation-based training has been shown to improve team performance in high-acuity obstetric emergencies such as postpartum hemorrhage, peripartum cardiomyopathy, and eclampsia, and simulation fellowships now train physicians to lead this education at over 50 U.S. programs. The geographic relationship between simulation fellowship presence and maternal mortality outcomes remains unexplored. This ecological study evaluates whether geographic areas with simulation fellowship programs have significantly lower maternal mortality rates than areas without such programs. Methods This ecological study examined maternal mortality rates from 2021–2023 obtained from the CDC WONDER database. These rates were calculated as maternal deaths per 100,000 population, and counties were classified by simulation fellowship presence (none, one, or two fellowships). he data collected was compared using Microsoft Excel, with significance set a priori at p < 0.05. Results Maternal mortality rates were similar between counties without simulation fellowships and those with at least one (0.14 vs. 0.14 per 100,000; p = 0.94). However, rates differed significantly when stratified by number of fellowships: 0.14 for no fellowships, 0.16 for one, and 0.10 for two (p = 0.03), with two-fellowship counties showing the lowest mortality. Discussion Overall fellowship presence was not associated with lower maternal mortality, but counties with two fellowships showed significantly lower rates. This finding is based on only two counties and requires cautious interpretation. As an ecological study, these results show association rather than causation. Further research with physician-level data is needed to clarify this relationship.

Introduction Trauma remains a leading cause of morbidity and mortality in the United States and places a substantial economic burden on the healthcare system. Although simulation-based training has been associated with improved trauma team performance and patient outcomes, whether emergency medicine simulation fellowship programs are associated with differences in trauma mortality remains unknown. This study examined whether counties with emergency medicine simulation fellowship programs differ in trauma mortality rates compared with counties without such programs. Methods County-level trauma mortality data (2021–2023) were obtained from the CDC WONDER Multiple Cause of Death database. The database was queried by county, year, and external cause of death. Trauma-related deaths were identified using ICD-10 external cause-of-death codes corresponding to blunt and penetrating injuries, excluding suicide. Counties with emergency medicine simulation fellowship programs were identified through publicly-available fellowship directories and classified according to the presence or absence of a simulation fellowship program. Trauma mortality rates were calculated by dividing the total number of trauma-related deaths by the cumulative county population for counties with and without simulation fellowship programs. The two mortality rates were compared using the rate ratio, 95% confidence interval, and P value calculated with the MedCalc online statistical calculator. Results Trauma mortality was 8.0 per 100,000 population in counties with emergency medicine simulation fellowship programs compared with 3.3 per 100,000 population in counties without fellowship programs (rate ratio, 2.45; PConclusion Contrary to our hypothesis, counties with emergency medicine simulation fellowship programs demonstrated higher trauma mortality rates. Because these programs are predominantly located in urban counties, these findings may reflect greater injury severity and higher emergency department volume rather than effects of the fellowship programs themselves. These factors should be considered when interpreting the association between emergency medicine simulation fellowship programs and trauma-related mortality.

Job preparation, engagement, and retention are crucial processes for retaining and supporting a quality workforce, and realistic job previews (RJPs), along with simulation-based training, play a crucial role in this process. In this paper, we bring together four sources of literature to review the translation of experiential and simulation-based training into tangible positive outcomes for organizations, most notably employee retention. This paper, relying on the foundational thinking of Kolb's (1984) experiential learning cycle, Issenberg et al.'s (2005) review of the features of high-fidelity simulation training programs, Jun and Eckardt's (2023) social exchange perspective on training and turnover, as well as Albtoosh, Ngah, & Yusoff's (2022) meta-analytic findings, demonstrates that high-quality simulation-based training not only enhances skill attainment but also fosters organizational identification and lower voluntary turnover. Research shows that quality training and development (with its features of feedback, repetition, variability, and integration) is a more important driver of turnover than quantity. By providing employees with structured simulation-based onboarding and real job previews, employers are likely to foster psychological readiness, loyalty, and retention among employees. The findings have implications for human resource strategies, training for industrial safety, and within other industries.

Drug overdose contributes to a significant portion of adolescent deaths. Studies have established the relationship between drug overdose rates and drug type and adolescent population cohort size, but there has been little research investigating a correlation between geographic region (Northeast, Midwest, South, and West) and adolescent drug overdose mortality rates. We hypothesized regional differences exist, and that the South would have the highest adolescent drug overdose rates, as relates to lowest socioeconomic status (SES). We determined the correlation between adolescent drug overdose rates and United States census region to determine whether regional differences exist. In this study, publicly-available CDC Wonder adolescent (18-24) drug overdose data (2018-2024) was filtered by census region and analyzed. A chi-squared test contingency test was done to determine the significance in correlation between adolescent drug overdose mortality rates and census region. We found the West census region had the highest drug overdose rates per 100,000 adolescents (14.8%), while the Northeast had the lowest rate (12.1%). A chi-squared contingency test was performed to determine the correlation between adolescent drug overdose mortality rate and census region. A statistically-significant difference among the census regions was found (χ² = 175.2, p <0.00001). Despite having the highest median income, the West had the highest mortality rate; in contrast, despite having the lowest median income, the South had only the third-highest mortality rate. We conclude adolescent drug overdose mortality rates differed between census region, though the results contradicted the hypothesis that there would be a consistently-inverse relationship between such mortality rate and census region SES (median income).

Introduction: In-hospital cardiac arrest carries high mortality despite standardized ACLS training. Educators face increasing time constraints in developing assessment tools for ACLS training. Two possible solutions to this problem are using pre-medical students or using artificial intelligence to generate test questions. This study compared the quality of pre-medical student-generated ACLS test questions vs. AI-generated ACLS test questions, testing the hypothesis that AI-generated questions are non-inferior to student-generated questions. Methods: Ten pre-medical students created ACLS questions following predefined criteria, while an AI model (Northwell’s Artificial Intelligence Hub) generated comparable questions. A blinded ACLS-certified physician evaluated questions on the qualities of Alignment, Clarity, Cognitive Level, and Question Design using a standardized rubric (Likert scale: 1 = poor quality, 5 = excellent). Student’s T-test and Chi-square analysis were used to compare the quality of questions on different rubric domains within each arm (student vs. AI) and within one domain (eg, question Clarity) between arms. The Student’s T test was used when 2 comparator groups were compared (eg, Clarity of student-generated vs. AI-generated questions) within one arm. The ANOVA test was used when comparing more than 2 comparator groups (eg, Alignment vs. Clarity vs. Cognitive Level) within one arm. Statistical significance was set as a priority at p <0.05. Results: Both student-generated and AI-generated questions were of high quality. AI-generated questions achieved the maximum score in the domains of Alignment, Clarity, and Question Design, but fell short of perfect scores in the domain of Cognitive Level (8 of 50 questions were less than 5). Student-generated questions achieved less-than-perfect scores in each domain. No significant difference was found in overall mean question scores between groups (students = 4.79, AI = 4.81; p = 0.9). However, AI-generated questions had significantly-greater Clarity (students = 4.8, AI = 5; p = .0461), while Alignment, Cognitive level, and Question Design showed no significant differences. Conclusion: AI-generated questions demonstrated overall quality comparable to those generated by pre-medical students, supporting the potential role of AI as a scalable tool in ACLS educational assessment development. Further studies are warranted to evaluate additional AI platforms and determine optimal integration of AI in medical education assessment design.

Introduction: Pneumonia is a common source of sepsis and carries significant morbidity and mortality. Prior research suggests patients with severe mental illness may receive disparate care and experience worse outcomes from infectious and cardiovascular conditions. Whether mental illness influences the radiographic presentation of pneumonia-related sepsis, which can guide antimicrobial selection and clinical decision making, remains poorly-understood. Methods: This retrospective study examined chest imaging findings in 202 adult septic patients with respiratory source infection presenting to a large tertiary care emergency department between December 2017 and December 2019. Patients were stratified by the presence (n = 51, 25.2%) or absence (n = 151, 74.8%) of a comorbid mental illness, defined broadly to include neurocognitive, mood, personality, psychotic, and substance use disorders. Radiographic findings, including parenchymal abnormalities, pleural effusions, and laterality, were systematically abstracted from the medical record and compared between groups using Chi-squared testing. Results: Patients with mental illness were more likely to have at least one radiographic finding (84% vs. 74%), though this difference did not reach statistical significance (p = 0.14). The average number of findings per patient was nearly identical between groups (3.14 vs. 3.12, p = 0.38), and no individual radiographic feature differed significantly between cohorts. Discussion: These findings suggest that, contrary to our hypothesis, mental illness may not be associated with the radiographic appearance of pneumonia in septic patients. Larger, diagnosis-specific studies are needed to evaluate whether specific psychiatric subgroups exhibit distinct imaging patterns.

This study explores the influence of social determinants of health (SDOH) on follow-up behavior among patients referred to community-based organizations (CBOs) in the Emergency Department (ED) of Long Island Jewish (LIJ) Medical Center. A retrospective analysis was conducted on data collected from 342 patients who were screened for SDOH between February and July 2023. Descriptive statistics and Chi-squared tests were used to identify potential associations between demographic and social factors (race, language, age, gender, employment status, and insurance status) and follow-up rates. The results revealed several trends: non-White patients (73.2%) and non-English speakers (81.8%) followed up more frequently than their counterparts, as did older adults (80.0%) and insured patients (77.8%). However, none of the variables reached statistical significance (all p-values > 0.05). The findings suggest that while demographic and social factors may influence follow-up behavior, the lack of statistical significance could be attributed to the limited sample size. These trends align with previous literature on SDOH and follow-up behavior, highlighting the need for further research with larger, more representative samples. Addressing the complex interplay of SDOH, including factors such as language, insurance, and cultural differences, is crucial for improving follow-up rates and ensuring better health outcomes for underserved populations. Future research should focus on refining referral systems, exploring additional socioeconomic factors, and conducting longitudinal studies to develop more effective strategies for integrating SDOH interventions in healthcare systems.